Multifunctional probe for minimally invasive surgery

Abstract

A probe for use in minimally invasive surgery incorporates a nozzle and electrode assembly at the distal end of the probe for achieving gas assisted electro-fulguration. In addition, the probe accommodates the simultaneous use of other auxiliary surgical instruments, such as standard electrosurgical electrodes, laser fiber optic conduits and mechanical tools. Further still, the probe includes a passageway for achieving evacuation, irrigation or aspiration at the surgical site. The probe thus allows a surgeon to achieve multiple different surgical functions during a minimally invasive surgical procedure without removing one probe and inserting a different probe to achieve a different surgical function.

The invention claimed is: 
     
       1. A probe for performing minimally invasive surgery through a cannula extending through a body wall of a patient and into a body cavity where the surgery is performed, comprising: a handle at a proximal end of the probe;   an elongated tube connected to the handle and extending to a distal end of the probe, the tube including a conduit and an electrical conductor which both extend along the length of the tube;   an assembly of a gas nozzle and an electrode positioned within the nozzle, the nozzle and electrode assembly connect to the tube at the distal end of the probe, the conduit communicating gas to the nozzle during gas assisted electro-fulguration, the electrical conductor is connected to the electrode for conducting electrical energy to the electrode during gas assisted electro-fulguration; and   the tube and the nozzle and electrode assembly having a predetermined configuration to permit the tube and the nozzle and electrode assembly to be inserted through the cannula and into the body cavity, the connection of the handle to the tube permitting the distal end to be positioned at a surgical site within the body cavity by manipulation of the handle.   
     
     
       2. A probe for performing minimally invasive surgery through a cannula extending through a body wall of a patient and into a body cavity where the surgery is performed, comprising: a handle at a proximal end of the probe;   an elongated tube connected to the handle and extending to a distal end of the probe, the tube including a conduit and an electrical conductor which both extend along the length of the tube, the tube having a predetermined configuration to permit the tube to be inserted through the cannula and into the body cavity, and the tube further having a predetermined length which is sufficient to extend the distal end 0f the probe through both the cannula and an open space within the body cavity to reach a surgical site within the body cavity and perform the surgery;   an assembly of a gas nozzle and an electrode positioned within the nozzle, the nozzle and electrode assembly retained in the conduit within the tube at the distal end of the probe, the conduit communicating gas to the nozzle during gas assisted electro-fulguration, the electrical conductor connected to the electrode for conducting electrical energy to the electrode during gas assisted electro-fulguration; and the nozzle and electrode assembly further comprises:   an elongated electrode;   a support structure connected to a rear end of the electrode and supporting the electrode in a forward projecting cantilever manner with a forward portion of the electrode exposed to gas flow therearound; and   a hollow sleeve connected to the support structure and surrounding the forward exposed portion of the electrode, an interior of the hollow sleeve forming the nozzle.   
     
     
       3. A probe as defined in claim 2, wherein: the support structure further includes an opening for conducting gas from the conduit into the interior of the sleeve.   
     
     
       4. A probe for performing minimally invasive surgery through a cannula extending through a body wall of a patient and into a body cavity where the surgery is performed, comprising: a handle at a proximal end of the probe;   an elongated tube connected to the handle and extending to a distal end of the probe, the tube including a conduit and an electrical conductor which both extend along the length of the tube, and the tube having a predetermined configuration to permit the tube to be inserted through the cannula and into the body cavity;   an assembly of a gas nozzle and an electrode positioned within the nozzle, the nozzle and electrode assembly connected to the tube at the distal end of the probe, the conduit communicating gas to the nozzle during gas assisted electro-fulguration, the electrical conductor connected to the electrode for conducting electrical energy to the electrode during gas assisted electro-fulguration; and   the tube further comprises a passageway separate from the conduit and the nozzle, said passageway extending along the length of the tube and communicating fluid with the distal end of the probe during a procedure involving the application of at least one of evacuation, irrigation or aspiration during the surgery in which gas assisted electro-fulguration is applied from the nozzle and electrode assembly.   
     
     
       5. A probe as defined in claim 4, wherein: the handle has a hollow interior;   the passageway extends into the hollow interior of the handle; and   the handle includes a fluid flow port communicating with the hollow interior and with the passageway for establishing fluid communication between the fluid flow port and the passageway.   
     
     
       6. A probe as defined in claim 5, wherein: the conduit communicates with the hollow interior of the handle;   the handle includes a gas electrosurgical port communicating with the hollow interior of the handle and with the conduit to establish gas communication from the gas electrosurgical port through the conduit to the nozzle and electrode assembly; and   the hollow interior of the handle includes a divider to divide the interior of the handle into a first fluid communication pathway and a second fluid communication pathway, the first fluid communication pathway extending between the gas electrosurgical port and the conduit in the tube, and the second separate fluid communication pathway extending between the fluid flow port and the passageway, the first and second fluid communication pathways being separate of one another.   
     
     
       7. A probe as defined in claim 6, wherein: the conductor extends through the conduit and the first fluid communication pathway and the gas electrosurgical port.   
     
     
       8. A probe for performing minimally invasive surgery through a cannula extending through a body wall of a patient and into a body cavity where the surgery is performed, comprising: a handle at a proximal end of the probe;   an elongated tube connected to the handle and extending to a distal end of the probe, the tube including a conduit and an electrical conductor which both extend along the length of the tube, and the tube having a predetermined configuration to permit the tube to be inserted through the cannula and into the body cavity;   an assembly of a gas nozzle and an electrode positioned within the nozzle, the nozzle and electrode assembly connected to the tube at the distal end of the probe, the conduit communicating gas to the nozzle during gas assisted electro-fulguration, the electrical conductor connected to the electrode for conducting electrical energy to the electrode during gas assisted electro-fulguration; and   the tube further includes means for supporting an elongated auxiliary surgical instrument for longitudinal movement along the tube at the distal end of the probe.   
     
     
       9. A probe for performing minimally invasive surgery through a cannula extending through a body wall of a patient and into a body cavity where the surgery is performed, comprising: a handle at a proximal end of the probe;   an elongated tube connected to the handle and extending to a distal end of the probe, the tube including a conduit and an electrical conductor which both extend along the length of the tube, and the tube having a predetermined configuration to permit the tube to be inserted through the cannula and into the body cavity;   an assembly of a gas nozzle and an electrode positioned within the nozzle, the nozzle and electrode assembly connected to the tube at the distal end of the probe, the conduit communicating gas to the nozzle during gas assisted electro-fulguration, the electrical conductor connected to the electrode for conducting electrical energy to the electrode during gas assisted electro-fulguration; and   a channel extending longitudinally through the tube and into the handle, the channel adapted to accept an elongated auxiliary surgical instrument.   
     
     
       10. A probe as defined in claim 9, wherein the channel is adapted to accept an auxiliary surgical instrument selected from a group consisting of a standard electrosurgical electrode, a laser fiber optic conduit, an aqua dissection conduit, and a mechanical tool. 
     
     
       11. A probe as defined in claim 9, wherein: the channel extends longitudinally through the tube and the handle between the proximal and distal ends of the probe to allow the replacement of one auxiliary surgical instrument with another auxiliary surgical instrument from the proximal end of the probe.   
     
     
       12. A probe as defined in claim 9, further comprising: a slider member connected to the handle and moveable along the channel; and   retaining means connected to the slider member and operative for selectively retaining an auxiliary surgical instrument to the slider member to achieve movement of the auxiliary surgical instrument with movement of the slider member.   
     
     
       13. A probe as defined in claim 12, wherein: the slider member includes an elongated slot forming a part of the channel and adapted for receiving the auxiliary surgical instrument.   
     
     
       14. A probe as defined in claim 13, wherein the retaining means comprises: a pivotable member pivotably connected to the slider member and having an eccentric surface moveable into the slot for contacting the auxiliary surgical instrument when the pivotable member is pivoted.   
     
     
       15. A probe as defined in claim 14, wherein: the pivotable member comprises a lock roller, and the eccentric surface includes a flat surface to hold the lock roller in a retaining position against the auxiliary surgical instrument.   
     
     
       16. A probe as defined in claim 9, further comprising: means connected to the tube for supporting and retaining an auxiliary surgical instrument within the channel to allow longitudinal sliding movement of the auxiliary surgical instrument along the channel.   
     
     
       17. A probe as defined in claim 16, wherein: the handle has a hollow interior;   the tube further comprises a passageway extending along the length of the tube and communicating with the hollow interior of the handle; and   the handle includes a fluid flow port communicating with the hollow interior and with the passageway for establishing fluid communication between the fluid flow port and the distal end of the probe through the passageway during a procedure involving the application of at least one of evacuation, irrigation or aspiration during the surgery.   
     
     
       18. A probe as defined in claim 17, wherein: the channel defines the passageway extending along and parallel to an auxiliary surgical instrument which is retained and supported in the channel.   
     
     
       19. A probe as defined in claim 18, wherein: the channel is defined by an interior surface of the tube;   the auxiliary surgical instrument includes a substantially cylindrical exterior surface;   the means for supporting and retaining the auxiliary surgical instrument within the channel comprises a curved support surface which contacts the exterior cylindrical surface of the auxiliary surgical instrument; and   the passageway exists between the exterior surface of the auxiliary surgical instrument and the interior surface of the tube.   
     
     
       20. A probe as defined in claim 19, wherein: the support surface and the exterior cylindrical surface of the auxiliary surgical instrument have approximately the same curvature;   the auxiliary surgical instrument is supported between the curved support surface and the interior surface of the tube along a longitudinal contact position which is opposite the support surface; and   the interior surface of the tube has a lesser degree of curvature than the exterior surface of the auxiliary surgical instrument along the longitudinal contact position.   
     
     
       21. A probe as defined in claim 20, wherein: the support surface extends along substantially the full length of the tube.   
     
     
       22. A probe as defined in claim 21, wherein: the longitudinal contact position extends along the length of the tube.   
     
     
       23. A probe as defined in claim 22, wherein: the auxiliary surgical instrument establishes longitudinal seals with the interior surface of the tube along the longitudinal contact position and along the curved support surface; and   the passageway is defined by the interior surface of the tube and the exterior surface of the auxiliary surgical instrument between the longitudinal seals.   
     
     
       24. A probe as defined in claim 23, wherein: the passageway extends on both transverse sides of the auxiliary surgical instrument.   
     
     
       25. A probe as defined in claim 24, further comprising: sealing means located within the interior of the handle and adapted for contacting the auxiliary surgical instrument and for confining fluid communication within the interior of the handle between the passageway and the fluid flow port.   
     
     
       26. A probe as defined in claim 25, wherein: the sealing means comprises a resilient elastomer membrane having an opening formed therein through which the auxiliary surgical instrument is inserted and by which a seal is established against the exterior of the auxiliary surgical instrument.   
     
     
       27. A probe as defined in claim 26, further comprising: pressure relief valve means connected to the handle and operative for releasing pressure communicated through the passageway to the interior of the handle.   
     
     
       28. A probe as defined in claim 27, wherein the handle further includes: a gas electrosurgical port through which a supply of gas for delivery from the nozzle during gas assisted electro-fulguration is supplied; and   a divider connected within the interior of the handle to divide the interior of the handle into one fluid communication pathway between the gas electrosurgical port and the conduit in the tube and into another separate fluid communication pathway between the fluid flow port and the passageway.   
     
     
       29. A method of performing minimally-invasive, gas-assisted electro-fulguration on a patient using a probe having an elongated tube extending to a distal end of the probe and a handle at a proximal end of the probe, comprising: inserting a cannula through a body wall of the patient;   expanding the body wall to form a body cavity in which to perform the electro-fulguration;   connecting an assembly of a gas nozzle and an electrode assembly to the tube at the distal end of the probe, the nozzle and electrode assembly having a predetermined configuration to allow the nozzle and electrode assembly to be inserted through the cannula into the body cavity;   inserting the distal end of the probe, the nozzle and electrode assembly and a portion of the tube through the cannula and into the body cavity;   directing the distal end of the probe within the body cavity to a surgical site by manipulating the handle outside of the body cavity and exterior of the body wall;   communicating gas through the tube to the nozzle during gas assisted electro-fulguration;   conducting electrical energy through the tube to the electrode during gas assisted electro-fulguration; and   performing gas assisted electro-fulguration at the surgical site by simultaneously delivering gas and electrical energy from the nozzle and electrode assembly at the distal end of the probe within the body cavity.   
     
     
       30. A method as defined in claim 29 further comprising: positioning an electrosurgical port on the probe at a position outside of the body cavity and exterior of the body wall;   extending a conduit through the tube from the electrosurgical port to the nozzle and electrode assembly; and   conducting gas and electrical energy through the electrosurgical port to the nozzle and electrode assembly.   
     
     
       31. A method as defined in claim 30 further comprising: extending a passageway along the tube to the distal end of the tube, the passageway being separate from the conduit and the nozzle; and   communicating fluid with the surgical site at the distal end of the probe by applying at least one of evacuation, irrigation or aspiration through the passageway.   
     
     
       32. A method as defined in claim 31 further comprising: positioning a fluid flow port on the probe at a position outside of the body cavity and exterior of the body wall;   conducting the fluid flow for the evacuation, irrigation or aspiration through the fluid flow port to the end of the passageway at the distal end of the probe;   dividing an interior of the handle into a first fluid communication pathway and a second fluid communication pathway, the first fluid communication pathway extending between the electrosurgical port and the conduit in the tube, and the second fluid communication pathway extending between the fluid flow port and the passageway; and   separating the first and second fluid communication pathways from one another.   
     
     
       33. A method as defined in claim 31 for use in performing an auxiliary surgical procedure at the surgical site in addition to gas assisted electro-fulguration, further comprising: extending the passageway longitudinally through the probe from the distal end of the tube into the handle;   positioning an elongated auxiliary surgical instrument in the passageway to extend a portion thereof from the distal end of the tube, the size of the passageway permitting the flow of fluid beside the auxiliary surgical instrument positioned in the passageway; and   performing the auxiliary surgical procedure by using the auxiliary surgical instrument while positioned in the passageway.   
     
     
       34. A method as defined in claim 29 for use in performing an auxiliary surgical procedure at the surgical site in addition to gas assisted electro-fulguration, further comprising: extending a channel longitudinally through the probe from the distal end of the tube into the handle;   positioning an elongated auxiliary surgical instrument in the channel to extend a portion thereof from the distal end of the tube; and   performing the auxiliary surgical procedure by using the auxiliary surgical instrument while positioned in the channel.   
     
     
       35. A method as defined in claim 34 further comprising: supporting the auxiliary surgical instrument in the channel to be moved longitudinally along the tube and relative to the distal end of the probe.   
     
     
       36. A method as defined in claim 34 further comprising: using an auxiliary surgical instrument selected from a group consisting of a standard electrosurgical electrode, a laser fiber optic conduit, an aqua dissection conduit, and a mechanical tool.   
     
     
       37. A method as defined in claim 34 further comprising: replacing the auxiliary surgical instrument with another auxiliary surgical instrument from the proximal end of the probe while the tube remains inserted through the cannula.   
     
     
       38. A method as defined in claim 29 further comprising: extending a passageway along the tube from the distal end of the tube to a relief position on the probe outside of the body cavity and exterior of the body wall;   communicating gas pressure within the body cavity through the passageway to the relief position; and   relieving excess pressure within the body cavity caused by the delivery of gas during gas assisted electro-fulguration by venting from the relief position the excess gas pressure communicated through the passageway.